Individual
MS. KRISTY MARIE WALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASSAGE THERAPIST
Contact information
Practice address
6221 SE 15TH ST, MIDWEST CITY, OK 73110-2623
(206) 380-9118
Mailing address
6221 SE 15TH ST, MIDWEST CITY, OK 73110-2623
(206) 380-9118
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
173821
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
173821
MASSAGE LICENSE
OK
Enumeration date
09/07/2021
Last updated
09/07/2021
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